As Wednesday 27th of July marks World Head and Neck Cancer Day, health agencies say it’s a timely opportunity to raise awareness about the devastating health impacts of head and neck cancers, including oropharyngeal (throat) cancer caused by Human Papillomavirus Virus (HPV).
The Head and Neck Cancer Foundation Aotearoa (HNCFA), the Head and Neck Cancer Support Network (HNCSN) and the Sexually Transmitted Infections Education Foundation (STIEF) is also reminding New Zealanders that prevention is available for free in the form of the Gardasil vaccine. This highly effective and safe vaccine prevents infection with HPV, and significantly reduces the risk of developing many different forms of cancer, including oropharyngeal cancer, cervical cancer and penile cancer.
This year, it is even more important because a significant proportion of our children have been missing out on this health prevention opportunity, due to the disruption brought by COVID-19, which is of great concern. In 2021, 53,000 fewer vaccines were delivered than in 2019, and the total reduction in doses over two years has been approximately 78,000 – that’s more than 30,000 Tamariki who have missed out.
HPV Head and Neck Cancer Survivor, Doug Russell, says “it was a no-brainer to vaccinate my children against HPV - they are all fully vaccinated with Gardasil. Knowing that they are protected from HPV-related cancers is one less worry on my mind.” “As a parent I do not want to be in a position later in life when our children could come to us with HPV and ask why they did not get vaccinated for this entirely preventable disease.”
HPV is one of the world’s most widespread viral infections, usually resulting from direct skin-to-skin contact during intimate sexual contact with someone who has HPV. Without immunisation, around 80 per cent of people who have ever had penetrative, or non-penetrative sexual (vaginal, oral, or anal) contact will be infected by at least one type of HPV at some point in their lives. Unfortunately, condom use during sex doesn't reliably prevent transmission of this virus.
Although there are over 150 types of HPV, only a small number of these are ‘high-risk HPV’ strains that have the potential to lead to cancerous changes in cells. HPV is a bit of an "unlucky dip” really: in many people, HPV is naturally cleared by the body’s immune system, some people will retain the virus but have low-risk strains that may lead to genital warts, whilst others may have the high-risk strains and develop devastating cancers - sometimes decades later - having never known about the original infection. It isn’t possible to predict which group your child will fall into if/when exposed to HPV, but it is possible to protect them by getting them vaccinated.
The virus is most commonly associated with cervical cancer, but can also cause other cancers in the genital area of people of all genders, specifically the vagina, vulva, penis, and anus. In recent years, medical professionals have also observed a rapid rise in HPV-related oropharyngeal cancer in heterosexual people who are otherwise healthy. For this group, the main risk is oropharyngeal cancer, which affects the throat (tonsils, base of tongue and soft palate). Although this type of cancer has traditionally been linked to smoking and heavy drinking, in recent years HPV has become the leading cause. Oropharyngeal cancers caused by HPV are rapidly rising in developed countries. In New Zealand, 95 new cases of HPV-related oropharyngeal cancer with 25 deaths were estimated for 2018. In 2020, there were 334 oropharyngeal cancer cases caused by HPV.
Doug Russell, an otherwise healthy 58-year-old, describes the lead-up to “the single toughest day” of his life in 2017. “I had a shave one lazy Sunday morning and there was nothing wrong with me. And at lunchtime, I was sitting in the kitchen having a sandwich, and I put my hand on my throat and I said to my wife Sarah “what is that lump?” And there was a big lump. “So on Monday, I went to the doctor and that started this whole thing, it just appeared overnight like that.”
Doug was infected with a high-risk strain of HPV, which he had never been aware of until it led to his cancer. “I thought I was living my life to the fullest, and I thought cancer was something that happened to other people. I really struggled, and still do struggle a little bit, to understand why this happened to me, and what the implications would be for my family.”
Doug’s experience of it happening ‘overnight’ is not uncommon. Head and neck cancers including oropharyngeal cancer are notoriously difficult to detect and, as a consequence, are often only discovered in advanced stages. Symptoms will often be very mild initially and will depend on where exactly the cancer is situated, how big it is and how far it has spread in the body.
The most common symptoms are:
- a painless lump in the neck or in front of the ear
- a lump or ulcer in the mouth, such as the tongue, gum, or inside the cheek
- a persistent white or red patch in the mouth
- a one-sided sore throat which may be associated with earache
- pain or difficulty with swallowing
- a hoarse voice, especially in a smoker
- difficult or noisy breathing
- a lump or sore on the face
- numbness or weakness on one side of the face
- one-sided blocked nose with bleeding
Many less serious conditions (apart from cancer) can cause these symptoms, but it is important to consult your doctor if they persist for more than 3 weeks.
Although many people with HPV-related oropharyngeal cancer survive following treatment, many patients suffer from long-lasting effects of the treatment.
Unlike cervical cancer, which can be screened for with a smear test, there is no simple way to screen for oropharyngeal cancer - but the great news, especially for young people, is that HPV infection and the cancers it causes are largely preventable. Vaccination against HPV infection has been available for many years and is highly effective and safe, with millions of doses administered worldwide. In New Zealand the HPV vaccine, known as Gardasil, is free for people aged from 9 years up to their 27th birthday. For those who have missed the school vaccination programme (year 8 students), the vaccine is available free of charge through their GP or health care provider. It is also safe to be given at the same time as other vaccines. As Dr John Chaplin, head and neck cancer surgeon and Board Member of the HNCFA, says “HPV-related oropharyngeal cancer affects both men and women. It is a devastating disease that can be prevented by HPV vaccination.”
Dr Cathy Stephenson, a GP with a special interest in youth health, says “I truly can’t think of a single reason not to get this vaccine. It’s safe, it’s free, it’s been extensively used and analysed around the world, and it prevents cancer. The average 21-year-old is unlikely to be thinking, ‘If I don’t get this vaccine now, I’m going to be at risk of cancer in 20 years’ time.’ But that is the reality – that’s when it’s going to hit you. Ask one of the increasing number of middle-aged men being diagnosed with cancers directly caused by exposure to HPV in their teens and 20s if it’s a vaccine worth having – had it been available for them, they wouldn’t be suffering now.”
While New Zealand is currently working towards a 75% HPV vaccination rate, uptake in Australia and the Pacific is around 90%. HNCFA and STIEF have been working collaboratively with Te Whatu Ora - Health New Zealand, to increase vaccination uptake and some exciting initiatives are currently being explored.
Rachel Mackay, Group Manager of Te Whatu Ora’s National Immunisation Programme, says: “We are committed to ensuring Tamariki and Rangatahi have equitable access to this cancer-preventing vaccine, and are working closely with our partners across the sector towards this goal. If the World Health Organization can implement a global strategy to eliminate cervical cancer through HPV vaccination, we have an opportunity to achieve the same outcome for HPV-related oropharyngeal cancer in New Zealand too.”
“We have a lot of work to do but there is no reason why we can’t achieve a 90% vaccination rate as our immediate neighbours have done, or more, as we have done with COVID-19, if we all collectively work towards this goal.” Says Dr Swee Tan, Chair of HNCFA. “Cancer diagnosis is devastating, and its treatment is harsh with short-term and long-term consequences. Prevention is better than cure.”
So, on Wednesday, as the world acknowledges the impact that head and neck cancers have on so many lives, HNCFA, HNCSN, and STIEF urge you to consider the young people in your lives – is your child one of the 30,000 that have missed out on the school-based vaccination programme? If they haven't had their Gardasil immunisations, book them in now!
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